Cryptosporidiosis: A Guide for Persons with HIV/AIDS

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What Is Cryptosporidiosis?

Cryptosporidiosis (krip-toe-spo-rid-e-o-sis), often
called "crypto," is a disease caused by a single-cell parasite, cryptosporidium parvum, which is too small to be seen without a microscope. Although sometimes people infected with cryptosporidium don't get
sick, when they do get sick they can have watery diarrhea,
stomach cramps, an upset stomach, or a slight fever. The first
symptoms of cryptosporidiosis may appear 2 to 10 days after a
person becomes infected. Crypto causes more severe and longer illness
in persons with AIDS than in other people.

How Does Cryptosporidiosis Affect Someone with a Weakened Immune
System?

In persons with severely weakened immune systems, especially
those with AIDS, cryptosporidiosis can be serious, long-lasting
and sometimes deadly. If your CD4 cell count is below about 200,
you are more likely to have diarrhea and other symptoms for a
long time. If your CD4 count is above 200 and you get crypto you
may feel better in about one to three weeks, but you might still
have the infection and be able to pass it to others even after
you feel better. If you are still infected and your CD4 count
later drops below 200, the crypto may act up again.

How Is Cryptosporidiosis Spread?

You can get crypto when you put anything in your mouth that has
touched the "stool" (that is, bowel movement) of a person or
animal with cryptosporidiosis. Cryptosporidia are too small to be
seen without a microscope by the naked eye. Cryptosporidiosis is not spread in
blood. The most common ways you can get crypto are touching your
mouth before washing your hands and after touching the stool of
infected persons, or touching the stool of infected animals, or
touching soil or objects contaminated with stool. You can also
get a cryptosporidium infection by drinking water contaminated
with stool or eating food contaminated with stool.

What Is the Treatment for Cryptosporidiosis?

Some drugs may reduce the symptoms of crypto, but no drug can
cure it. New drugs are being tested. If you think you have crypto
talk about testing and treatment with your health care provider.
You can also drink an oral rehydration therapy mix, to avoid
getting dehydrated. You can buy these mixes at drug stores and
sports stores.

How Can I Prevent Cryptosporidiosis?

There are many things that you can do to reduce your risk of
getting crypto. The more things you do, the better your chances
of avoiding cryptosporidiosis. These actions will also help
protect you against other diseases.

Wash your hands.
Washing your hands often with soap and water is probably the
single most important thing you can do to avoid crypto and other
illnesses. Wash your hands well after touching children in
diapers; after touching clothing, bedding, or bed pans soiled by
someone who has diarrhea; after gardening; any time you touch
pets or other animals; and after touching anything that might
have had contact with even the smallest amounts of human or
animal stool. Even if you wear gloves when you do these
activities you will still need to wash well when you finish.
Always wash your hands before preparing food to avoid spreading
any infections you might have to others. Supervise hand washing
by HIV-infected children.

Avoid sex that involves contact with stool.
Infected persons may have cryptosporidium on their skin in the
genital area, including the thighs and buttocks. However, since
you cannot tell if a person has cryptosporidiosis, you may want
to take these precautions with any sex partner:

don't kiss or lick the genitals or anus

wash your hands well after touching your partner's anus or
rectal area

Rimming (licking the anus) is so likely to spread infection that
you should avoid it, even if you and your partner wash well
before.

Avoid touching farm animals.
If you touch a farm animal, particularly a calf, lamb or other
young animal, or visit a farm where they are raised, wash your
hands well with soap and water before preparing food or putting
anything into your mouth. Do not touch the stool of any animal,
including any stool you find on your shoes or boots.

Avoid touching the stool of pets.
Most pets are safe to keep. However, you should have someone else clean
the litter boxes of cats and dispose of the stool of other
animals. If someone else cannot help you, use disposable gloves
when handling anything that might be contaminated by the stool of
pets. Wash your hands after taking off the gloves. The risk of
getting crypto is greatest from pets less than six months old and
animals that have diarrhea. Older animals can also have
cryptosporidiosis, but they are less likely to be sick or to
pass the disease to humans. If you are getting a puppy or kitten
that is less than six months old, have your veterinarian test the
animal for crypto before bringing it home. Do not adopt a stray
animal. If your pet develops diarrhea later, have your
veterinarian test it for cryptosporidiosis again. Wash your hands
after touching any animal.

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Wash and/or cook your food.
Vegetables and fruits that may have touched soil or water might
be contaminated. Wash vegetables or fruit you will eat uncooked.
If you choose to take extra steps to make your water safe (see
below for ways to make sure that your water is safe), you should
rinse your fruits and vegetables only with a stream of this safe
water. You can also peel fruit that you will not cook. Do not eat
or drink unpasteurized milk or dairy products. Cooking kills
cryptosporidium. Cooked food and processed or packaged foods are
probably safe after cooking or processing if they are not handled by an infected person.

Be careful when swimming in lakes, rivers, pools, or jacuzzis.
Be careful when swimming in lakes, rivers, public pools, or
jacuzzis because of the risk of swallowing contaminated water.
If you do go swimming, don't swallow any water.

Drink safe water.
Don't drink water directly from lakes, rivers, streams, or
springs. You may wish to avoid drinking tap water. Because public
water quality and treatment varies in the United States, you
should check with your local health department and water utility
to see if they have made any recommendations for HIV-infected
persons about drinking local tap water. There are three extra
measures you may wish to take to ensure that your drinking water
is safe: boil your water, filter your water with certain home
filters, or drink certain types of bottled water. Processed
bubbly drinks in cans or bottles are probably safe also. If you
choose to take these extra measures, take them all the time, not
just at home. If your local public health office warns you to
boil your water, don't drink tap water unless you make it safe.
Here are some extra measures you may wish to take to make sure
your water is safe:

Boiling water: Boiling is the best extra measure you may wish
to take to be sure that your water is free of cryptosporidium and
any other germs. You yourself can see that the water was boiled
and that it was stored safely. Bring your water to a rolling boil
and let it boil for one (1) minute. After your boiled water
cools, put it in a clean bottle or pitcher with a lid and store
it in your refrigerator. Use the water as you normally would.
Ice made from contaminated water can also contain
cryptosporidium. To be safe, make your ice from boiled water.
Water bottles and ice trays should be cleaned with soap and water
before you use them. Do not touch the inside of your water
bottles or ice trays. If you can, clean your water bottles and
ice trays yourself.

Filtering tap water: There are many different kinds of home
water filters, but not all of them remove cryptosporidium. If you
want to know if a particular filter will remove cryptosporidium,
call NSF at 1-800-673-8010. NSF is an independent testing group.
If you want a list of filters that remove cryptosporidium, call,
write or fax NSF and ask for their "Standard 53 Cyst Filters"
list. You can reach NSF at:

If you choose to buy a filter, look for this information on the
label:

Water Filter Label Information
What to Look for on the Filter Label

Promises the filter removes cryptosporidium

Does not promise the filter removes cryptosporidium

Tested and certified by NSF Standard 53 for cyst removal

Tested and certified by NSF Standard 53 for cyst reduction

Reverse osmosis

Absolute micron size of one micron or smaller

Nominal one micron size

Effective against giardia

Effective against parasites

Carbon filter

Water purifier

EPA approved

Activated carbon

Removes chlorine

Ultraviolet light

Pentiodide resins

Filters collect germs from your water, so you should have a
friend who is not HIV positive change the filter cartridges for
you or wear gloves and wash your hands if you must do it
yourself. Filters may not remove cryptosporidium as well as
boiling, because some filters may not seal tightly or they may
have other defects.

Bottled water: If you choose to drink bottled water, read the
bottle label and look for this information:

Bottled Water Label Information
What to Look for on the Bottled Water Label

Promises the water has no cryptosporidium

Does not promise the water has no cryptosporidium

Reverse osmosis treated

Distilled

Filtered through an absolute one micron or smaller filter

Filtered

Micro-filtered

Carbon-filtered

Particle-filtered

Multimedia-filtered

Ozonated

Ozone-treated

Ultraviolet light treated

Activated carbon-treated

Carbon dioxide-treated

Ion exchange-treated

Deionized

Purified

Chlorinated

Well water

Artesian well water

Spring water

Mineral water

Store-bought bubbly drinks: Although no group tests prepared
bubbly drinks like sodas and beer for cryptosporidium, the water
that is used for these drinks is usually filtered or heated
enough to kill cryptosporidium. Cryptosporidium is also killed
when the drinks are mixed in the factory. So, sodas and other
canned or bottled bubbly drinks can be assumed to be safe. Sodas
not in a bottle or can or non-bubbly drinks may be made with tap
water so they may not be safe. Hot tea and coffee also have no
cryptosporidium.

Take extra care when traveling.
If you travel to developing nations you may be at a greater risk
of getting cryptosporidiosis. Foods and drinks, in particular raw
fruits and vegetables, tap water or ice made from tap water,
unpasteurized milk or dairy products, and items purchased from
street vendors may be contaminated with cryptosporidium. You
should avoid these items. Steaming hot foods, fruits you peel yourself,
bottled and canned processed drinks and hot coffee or tea are
probably safe to drink. Avoid swallowing water when swimming and
avoid swimming in water that may be contaminated with human or
animal waste. Talk with your health care provider about other
precautions you may want to take when you travel abroad,
especially in developing countries.

For more information on cryptosporidiosis, call the CDC AIDS
Hotline at 1-800-342-AIDS.

A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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